ICU Presentation 3

ICU Patient Presentation Notes

1. Purpose & Mindset

• Goal: Communicate patient’s current status clearly, concisely, and with interpretation (not just reciting numbers).

• Approach:

  • Low-stress environment → clear thinking.

  • Attending often already knows the numbers; your role is to synthesize and analyze.

  • Focus on why things matter, not just what the values are.

  • Rounds are for teaching and improving care, not just data transfer.

• Repetition builds skill – like working out at the gym.

2. General Presentation Flow

1. One-liner – succinct summary.

2. Overnight events – what happened since last seen.

3. Vital signs – with interpretation.

4. I/Os – ins and outs.

5. Ventilator status (if applicable).

6. Lab data & cultures – highlight trends, not just raw numbers.

7. Imaging – review both radiologist read & your own interpretation.

8. Lines, tubes, drains – duration, necessity, complications.

9. Medications – know them well, especially antibiotics, drips, and fluids.

10. Physical exam – focused but thorough.

11. Assessment & Plan – your chance to think critically (system-based vs problem-based).

3. Step-by-Step Details

A. One-Liner

• Format:

  • Patient name (or placeholder, e.g. Jane Doe).

  • Age, sex.

  • Hospital day number.

  • Main reason for admission/current issue.

• Example:

  • “Jane Doe is a 68-year-old female, hospital day 6, admitted for COPD exacerbation.”

• Why include hospital day?

  • Context: prolonged vent = start thinking about trach, prolonged stay = reassess goals of care.

B. Overnight Events

• Key clinical changes (e.g., self-extubation, hypotension, anuria, code events).

• Sources: handoff from night team, nurse reports (vital resource).

• Present like “jabs” and “uppercuts” → concise, high-yield.

C. Vital Signs

• Don’t just read ranges → interpret and contextualize.

• Temperature:

  • Normal vs febrile?

  • Were antipyretics given?

• Oxygenation:

  • SpO₂ values with oxygen delivery method (e.g., 96% on 2L NC).

  • Ventilated? Note changes in settings.

• Respiratory rate:

  • On vent vs spontaneous?

  • Over-breathing the set rate?

• Blood pressure:

  • MAP preferred in ICU patients.

  • If on pressors: which drug, dose, trend (up/down overnight).

  • If given antihypertensives, note PRNs.

D. Intake & Output (I/Os)

• Net balance over last 24h and total hospitalization.

• Urine output: hourly trends, boluses given, response.

• Inputs: fluids (type, rate, boluses), IV meds, nutrition.

• Outputs: urine, drains (surgical, chest tube), stool, vomiting.

• Note: consider insensible losses → I/O not 100% accurate.

E. Ventilator (if applicable)

• Know mode (AC/VC, SIMV, pressure support, APRV, etc.).

• Report:

  • Mode

  • FiO₂

  • PEEP

  • Tidal volume

  • Set RR vs actual RR

  • Driving pressures if relevant

• Interpretation: patient synchrony, over-breathing, desaturations.

• Use RT input as resource.

F. Lab Data & Cultures

• CBC:

  • Report trends (WBC up/down, Hgb stable vs dropping, Plt counts).

  • Contextualize: steroids raising WBC? Bleeding explaining Hb drop?

• CMP/BMP:

  • Electrolyte trends (Na, K, Mg, Phos).

  • Correlate with medications/fluids.

  • Renal function (BUN, Cr trends matter more than one value).

• Glucose: ranges over last 24h, not just one number.

• Cultures:

  • Blood, urine, respiratory, others.

  • Date/time drawn, growth status.

  • Guides abx decisions.

G. Imaging

• Always look at images yourself + review radiologist read.

• Common: CXR, CT, echo.

• Echo: don’t just mention EF → note RV, valves, pressures.

• Identify trends/progression compared to prior studies.

H. Lines, Tubes, Drains

• Central lines, arterial lines, Foley, chest tubes, drains, ETT, trach.

• Always ask: Does this still need to be in?

• Prolonged devices → risk of infection → remove if unnecessary.

I. Medications

• Antibiotics: name, indication, duration so far.

• Pressors/inotropes: dose trends.

• IV fluids: type, rate.

• Insulin: sliding scale requirements → need for basal insulin?

• Be prepared to suggest escalation or de-escalation.

J. Physical Exam

• Tailored, focused, but complete enough to matter.

• Start with context:

  • Sedated/intubated? On what drips? (affects neuro exam).

• Neuro: level of consciousness, commands, localizing to pain, stroke screen.

• CV: heart sounds, edema, pulses.

• Resp: breath sounds, wheeze/rales, chest expansion.

• GI: distension, bowel sounds, drains.

• Skin: perfusion, pressure injuries, rashes.

• Keep concise but meaningful.

K. Assessment & Plan (not fully detailed here)

• Institution-dependent: problem-based vs system-based.

• This is your time to shine: demonstrate clinical reasoning.

• Always link data you presented → to actionable plan.

4. Key Tips

• Don’t just recite → synthesize.

• Use trends and context, not isolated numbers.

• Think out loud: why does this lab, vital, or event matter?

• Always tie presentation back to improving the patient’s care.